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Akron Univ. School of Law

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Sunday, November 14, 2004

Ancestry v. Race and Drug Safey and Efficacy

As recent studies show that drugs may have different safety and efficacy results depending on a person's race, the Wall Street Journal reports on other research that demonstrates that one's ancestry has a more important impact that one's race on whether a drug will benefit the individual.   A brief summary of the Wall Street Journal report follows:

Daily Policy Digest
Health Issues: Thursday, November 11, 2004

Studies claim that at least 29 medicines are safer for some racial groups than others, strongly suggesting that race is biologically real, reports the Wall Street Journal.

  • A drug for congestive heart failure had failed in two large clinical studies in the 1980s that included both blacks and whites; but in a trial enrolling only African Americans, the outcome was dramatically different.
  • Those receiving the drug BiDil did so much better than those receiving a placebo, announced manufacturer NitroMed, that it was ethically obliged to halt the trial and offer BiDil to all participants.

But new genetic data shows that racial categories are far too broad. For one thing, there is more variation within a race than between races. A white person and a black person may be more genetically similar, measured by the amount of DNA they have in common, than two blacks, says the Journal:

  • About 30 percent of white Americans have enough non-European ancestry -- more than 10 percent -- to make self-reported race an unreliable indicator of their generic make-up.
  • Many of these people might be good candidates for BiDil, but if their doctors see them as white they won’t receive it, notes Howard University biologist Charles Rotimi.

As a result, geneticists are inching away from the blunderbuss category of race and toward the more precise one of ancestry.

Ancestry reflects genetic variants fairly precisely, says the Journal. Thus, a smaller ethnic grouping, such as Cheyenne or Irish, reflects real genetic differences. But they get washed out when you use the larger category of race.

Francis Collins, director of the National Human Genome Institute, says that every attempt should be made to determine individual genetic profiles and stop using race, which is a very poor proxy for genetic variants that affect health.

Source: Sharon Begley, “Ancestry Trumps Race in Predicting Efficacy of Drug Treatments,” Wall Street Journal, October 29, 2004.

The WSJ text (subscription required)

For more on Health Care and Drugs, see http://www.ncpa.org/iss/hea/

http://lawprofessors.typepad.com/healthlawprof_blog/2004/11/ancestry_v_race.html

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Comments

Re: The First Race-Based Medicine
Are Black Americans Encountering Another “Tuskegee" Experiment?

I can understand how some medications can be designed for persons who have a very specific genetic background. However, black Americans are not an isolated racial group. To the contrary, black Americans are probably one of the most genetically diverse groups of people who have ever existed.

Black Americans beyond having an eclectic genetic connection to the multiple peoples who inhabit West Africa, many black Americans have both European and Native American ancestry. And let us not fail to mention about blacks immigrating from Africa and the Caribbean to the United States, who become “black Americans”, once they reach these shores. Are medications made for “black Americans” beneficial to the newest arriving black Americans?

My brother, who is a black American, suffers with idiopathic torsion dystonia, a neurological movement disorder that has its highest incidence among the European Jewry. Many of his doctor’s are baffled that a black man has this rare disease, until they probe for my brother’s known genetic history. Our maternal great grandfather was a German Jew. Many black Americans have similar mixed ethnic identities, although we are socially and self-identified as black Americans.

We must be careful that the development of race based drugs like BiDil is not directed by misguided science. I hope that scientists are not allowing mistaken perceptions of race and pharmaceutical companies their greed to cloud the scientific process, by incorrectly manufacturing and marketing drugs based on race.

Moreover, we must ensure that the black community is not used for 21st Century medical experimentation, like blacks were used in the Tuskeegee experiment.

Benin Dakar
Duluth, GA

Posted by: Benin Dakar | Jun 20, 2005 11:26:59 AM

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